Commentary: Should we move away from an attachment framework for understanding disinhibited social engagement disorder ( DSED )? A commentary on Zeanah and Gleason (2015)

Zeanah and Gleason have contributed a very informative and comprehensive review of the considerable recent advances in understanding reactive attachment disorder ( RAD ) and disinhibited social engagement disorder ( DSED ). Research in the past 15 years has grounded these diagnoses in a solid evidence base, due to the sophisticated work carried out by investigators of the ERAS and BEIP studies, as well as other efforts. The authors do an elegant job of synthesizing this new evidence and highlighting the questions and current controversies that emerge from so much new information. Given the scope of their task, they had limited space to elaborate on underlying etiological and conceptual models for these disorders and, in particular, the conceptual controversy underlying the recent DSM ‐5 decision to relabel Reactive Attachment Disorder‐ Indiscriminate Type to Disinhibited Social Engagement Disorder. That change essentially turns on whether DSED should be considered a disorder of attachment or a disorder with a nonattachment‐related etiology. This is an important controversy that will define research agendas for future studies and that goes to the heart of how to mount effective interventions for DSED . Thus, it is important to clarify the conceptualizations of etiological mechanisms that might underlie DSED .